Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery

Abstract

Background Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). Methods An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. Results The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. Conclusions The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Risk Factors for Corneal Endothelial Decompensation after Penetrating Keratoplasty: A Population-Based Cohort Study

“…A study published in 2023, utilizing intracameral moxifloxacin and dexamethasone, found a mean ECD decrement of 6.2% [35]. Additionally, an analysis of selected studies published between 2015 and 2021 on postoperative corneal endothelial cell loss following phacoemulsification with intracameral antibiotics, which have been increasingly used in recent years, revealed that the reported means of endothelial cell loss ranged between 3.6% and 14.5% [35]. Moreover, corneal decompensation, as well as bullous keratopathy after cataract surgery, is a major indication for PK surgery [4].…”

“…The extent of endothelial cell loss is variable but has been frequently reported to be higher than 5%. A study published in 2023, utilizing intracameral moxifloxacin and dexamethasone, found a mean ECD decrement of 6.2% [35]. Additionally, an analysis of selected studies published between 2015 and 2021 on postoperative corneal endothelial cell loss following phacoemulsification with intracameral antibiotics, which have been increasingly used in recent years, revealed that the reported means of endothelial cell loss ranged between 3.6% and 14.5% [35].…”

New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis

“…Currently, there is a packaged formulation of cefuroxime approved in Europe (Aprokam ® , Laboratories Théa, Clermont-Ferrand, France). In the US, there is no approved medication and no universally accepted dose of “off-label” medication, although 500 μg of the preservative-free formulation of moxifloxacin (Vigamox ® , Alcon, Fort Worth, TX, USA) is widely used [ 124 , 125 ].…”